Tendon and Ligament injuries

Question 1

define the term tendinopathy

Answer 1

any form of injury to a tendon

Question 2

give some causes of acute tendon rupture

Answer 2

overuse
eccentric activity
rapid acceleration or deceleration

Question 3

give characterisitcs of the classical presentation of a tendinopathy

Answer 3

insidious onset

a specific site of pain

pain when person first starts to mobalise that eases after a period of warm up

pain following activity

Question 4

give some examples of intrinsic causative factors for tendinopathy

Answer 4

gait 
heavy heal strike 
motor patterning 
age 
BMI 
previous injury

Question 5

give some examples of extrinsic causative factors for tendinopathy

Answer 5

footwear
types of exercise mainly plyometrics
medications
sudden increases in volume or intensity of training

Question 6

outline the three stages of the contimuum model for tendinopathy development

Answer 6

1) diffuse increased cellularity and ground substance
2) focal areas of collagen disorganization and neurovasular ingrowth
3) discrete islands of degenerative tendinopathy

Question 7

describe what is seen in reactive tendinopathy

Answer 7

a non-inflammatory respinse seen to acute overload

increased proteoglycans which lead to water being drawn in via osmosis

therefore there is an increase in ground substance

fluid pressure or hypersensitive tenocyte = pain

Question 8

how does rest help the tendon to recover in reactive tendinopathy

Answer 8

allows level of proteoglycans to decrease back to normal levels

Question 9

describe what is seen in dysrepair tendinopathy

Answer 9

matrix becomes disorganised and collagen becomes seperated

tendon is thickened due to collogen becoming separated and ground substance forming

upregulation of VEGF to cause neo-vascularisation

glutamate and substance P also released which could be the cause of pain

Question 10

describe what is seen in degenerative tendinopathy

Answer 10

significant collagen matrix disorganisation
‘holes’ within the tendon
increase in type 3 collagen
apoptosis of tenocytes

Question 11

what areas do rehab programmes for tendinopathy focus on

Answer 11

pain reduction
increasing range of motion
address contractile deficit caused by lack of use
address and reinforce movement patterns to prevent recurrence

Question 12

what is meant by stress shielding

Answer 12

a period of unloading of the tendon to protect it and allow some repair to take place

Question 13

explain how isometrics are used in the first stage of recovery from achilles tendinopathy and what are the benefits of doing these exercises

Answer 13

stand on toes of the effective leg for 30-60 seconds
4 sets up to 5x per day

addresses contractile deficit
reduces pain and cortical inhibition

Question 14

what is the second stage of rehab from achilles tendinopathy

Answer 14

progressive concentric and eccentric loading

these are slow, controlled movements through the range of motion to address contractile deficit

Question 15

what is the third stage or rehab from achilles tendinopathy

Answer 15

heavy loading through the range of movement

Question 16

when can a person who is recovering from tendinits move on to energy storage loading training

Answer 16

when there is minimal pain

or when limb strength is equivalent to the uninjured limb

Question 17

describe what is meant by visoelasticity in relation to ligaments

Answer 17

will strain when under tension and then return to their original shape when tension is removed

Question 18

under what conditions would a ligament not return to its original shape

Answer 18

excessive strain
under strain for a long period
strained very quickly

Question 19

what characterisitc of the microstructure of a ligament allow it to stretch

Answer 19

the collagen fibres aren’t perfectly parallel

Question 20

describe the grading system for ligamentous injuries

Answer 20

1 = sprained or stretched ligament but it is still compatent and able to stablise the joint

2= partial tear, still able to provide some stability and healing is possible

3 = complete tear so unable to stablise the joint

Question 21

explain the non-surgical management options of ligament injuries

Answer 21

1) muscle strengthening to compensate

2) improve proprioception to increase how quickly the surrounding muscles will react

Question 22

what is the general treatment outline for reactive tendinopath and early tendon dysrepair

Answer 22

load reduction to allow the tendon to react

Question 23

what is the general treatment for tendon dyrepair and degenerative tendinopathy

Answer 23

physical activity which stimulates cell activity and protein production